MEMPHIS, Tenn. — Overreliance on 911 has led to a $20 million annual shortfall in the Memphis Fire Department’s EMS budget. It’s a problem many departments are facing.
Memphis Division Chief Andrew Hart says the number of ambulance rides increased 24 percent to more than 124,000 trips each year from where it was five years ago.
Also, while the city’s population has stayed at 650,000 since the 1970s, the distance EMS travels has vastly increased. The city has doubled in size from 170 to 350 square miles. This has contributed to there being times when ambulances are not available for service calls.
The high 911 call volume in Memphis is very complex, says Masharn Austin, a workforce strategist on the city’s IBM team. A lack of readily accessible transportation is one reason why, he says.
“Calling 911 is purely a function of not being able to get to basic care,” says Austin.
For others, it’s upfront cost. By 2014, the poverty rate in Memphis was 30 percent.
“We recognize our answer for the past 50 years is if you call 911, we will give you a ride to the hospital,” Hart says, adding that in Memphis, there are two options — call 911 and pay nothing up front, or find a ride and pay to see a doctor. “It almost leads people to call 911.”
Data-driven change
Memphis was one of 600 cities worldwide to apply, and one of 16 selected, for the 2015 IBM grant because of the opportunity to align a major problem with data-driven solutions.
“Our goal is being brilliant at the basics,” says Doug McGowan, chief operating officer for Memphis. He’s part of Mayor Jim Strickland’s innovation delivery team, which is charged with helping to make Memphis as effective and efficient as it can be.
The city had already done some thinking on how to reduce calls by establishing programs that put health care navigators in the community and nurse dispatchers on the telephone to find other solutions for frequent 911 callers.
IBM’s data crunching, which included using its Watson Analytics predictive analytics and data visualization tool, validated the programs. City officials say the results are giving them the confidence to keep moving forward with paramedicine and telemedicine programs they started last year.
An overview of the analysis revealed some 2,000 frequent 911 callers for the navigators to work with.
Number crunching
“It’s something that we struggled with. Having outside experts was huge,” says Hart. “Working with IBM is very beneficial in showing insurance companies that the cost savings [of the paramedicine program] is beneficial.”
Other IBM findings can help focus the city on solutions for those who use the 911 system. For example, a heat map reveals the zip codes with the highest volumes of calls.
New health care opportunities based in those areas or transportation vouchers to travel to points of health care could start reducing the number of 911 calls from those areas.
“We have to think differently,” McGowan says. “We have to think about the customer journey … We’re thinking from the point of service backwards.”
The IBM team arrived in Memphis in late February and spent about 10 days conducting more than 80 stakeholder interviews and gathering all relevant data from various city departments.
The key findings centered on the 911 process, collaboration among city departments, gaps in service, transportation issues, incentives and disincentives, educating the community and funding.
Surfacing smarter solutions
“This is not something one group could do on their own,” Hart says.
Austin agrees. “A lot of the things Memphis was doing, they were doing a good job at; they were just doing it in silos,” he says.
IBM expects to have the final report finished in May. Meanwhile the team’s preliminary recommendations are focused on collaboration among health care stakeholders, innovating Memphis’s 911 process, providing health care service alternatives, creating incentives and impactful corrective actions and launching a citywide education campaign.
On a micro level, some recommendations like consolidating systems data or establishing mobile health units are going to take time, money or collaboration from the city’s partners.
However, Austin points out that while the costs for some recommendations might be high, such as $500,000 per year just to operate a mobile health unit, the return on the investment is justified. One long-operating mobile health care unit in Boston shows a 36:1 return.
“It’s unbelievable the impact you can have in the community by providing immediate care,” Austin says.
IBM summarized recommendations based on the magnitude of the impact and how hard or easy each solution would be to implement.
Shame on you
Other recommendations, like empowering EMS to treat on-scene and EMS initiated refusal, will be hard to implement but would have high impact in addressing the problem. Memphis is debating the possibilities now.
McGowan says that there are opportunities for paramedics to treat on scene and get ambulances back out for service faster.
“We have faith and confidence in our front lines to make decisions,” McGowan says.
However, Hart cautions over legal concerns. The city has engaged its risk management team to look into what would be required to give EMS the authority, qualifications, and compliance.
A major piece is educating residents on when to call 911, and when they really shouldn’t. IBM recommends campaign messaging based on what are the consequences of calling 911 just to get a ride.
“It’s educating people through shaming,” Austin says.
While 911 shaming might not be the specific focus of a public outreach campaign, Memphis began talking this week with film production crews about the success of negative ad campaigns, such as the National Council Against Smoking’s campaign. Memphians may save some lives by not tying up an ambulance to go and fill a prescription.
And for a department struggling to rein in runaway 911 overuse costs, even embarrassing its residents for system abuse is not too far-fetched.